MercyOne Dyersville Medical Center
1111 Third St. SW, Dyersville, IA · MercyOne · · NPI 1205816725
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Tc-99m pertechnetate per mci HCPCS A9512 | $99.30 | $99.30 | $37.54 – $111.77 | 40 |
| Tc-99m pyroph diag per dose up to 25 mci HCPCS A9538 | $335.80 | $335.80 | $126.93 – $377.98 | 40 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $221.60 | $221.60 | $83.76 – $249.43 | 40 |
| Tc-99m succimer (dmsa) HCPCS A9551 | $2,988.10 | $2,988.10 | $1,129.50 – $3,363.41 | 40 |
| Tc-99m sulfur colloid HCPCS A9541 | $855.40 | $855.40 | $323.34 – $962.84 | 40 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | $198.05 | $198.05 | $74.86 – $222.93 | 40 |
| Tc-99m tilmanocept diag HCPCS A9520 | $2,740.00 | $2,740.00 | $1,035.72 – $3,084.14 | 40 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $99.45 | $153.00 | $57.83 – $172.22 | 40 |
| T cells total count CPT 86359 | $91.65 | $141.00 | $36.98 – $141.00 | 40 |
| Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution HCPCS J9274 | $107,550.00 | $107,550.00 | $23,757.00 – $121,058.28 | 111 |
| Telavancin injection HCPCS J3095 | $3,365.50 | $3,365.50 | $560.25 – $3,788.21 | 111 |
| Telehealth original site facility fee HCPCS Q3014 | $52.00 | $80.00 | $30.24 – $90.05 | 40 |
| Temozolomide 100 mg intravenous solution HCPCS J9328 | $5,015.55 | $5,015.55 | $1,137.00 – $5,645.50 | 111 |
| Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln HCPCS J9330 | $10,501.70 | $10,501.70 | $3,969.64 – $11,820.71 | 40 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $23,582.35 | $23,582.35 | $4,298.50 – $26,544.29 | 111 |
| Terbutaline 1 mg/ml subcutaneous solution HCPCS J3105 | $92.00 | $92.00 | $34.78 – $103.56 | 40 |
| Test pathogen(s) for platelets reference HCPCS P9100 | $73.45 | $113.00 | $42.71 – $127.19 | 40 |
| Tetanus immune globulin inj HCPCS J1670 | $2,622.15 | $2,622.15 | $577.05 – $2,951.49 | 111 |
| Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe HCPCS J2356 | $22,937.05 | $22,937.05 | $8,670.20 – $25,817.94 | 40 |
| Theophylline therapeutic drug level CPT 80198 | $117.00 | $180.00 | $68.04 – $202.61 | 40 |
| Therapy Activity Training (each 15 minutes) CPT 97530 | $128.70 | $198.00 | $74.84 – $222.87 | 40 |
| Therapy Exercise Session (each 15 minutes) CPT 97110 | $129.35 | $199.00 | $75.22 – $223.99 | 40 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | $8.30 | $8.30 | $1.79 – $9.34 | 111 |
| Thigh Bone (Femur) X-ray (both sides) CPT 73552 | $403.65 | $621.00 | $156.49 – $466.00 | 40 |
| Thiotepa 15 mg solution for injection HCPCS J9341 | $1,090.00 | $1,090.00 | $412.02 – $1,226.90 | 40 |
| Thrombin time CPT 85670 | $33.80 | $52.00 | $5.65 – $52.00 | 40 |
| Thromboplastin time partial (ptt) substitution fractions each CPT 85732 | $41.60 | $64.00 | $24.19 – $72.04 | 40 |
| Thyroglobulin antibody CPT 86800 | $122.20 | $188.00 | $71.06 – $211.61 | 40 |
| Thyroid (TSH) Test CPT 84443 | $124.80 | $192.00 | $72.58 – $216.12 | 40 |
| Thyrotropin alfa 0.9 mg intramuscular solution HCPCS J3240 | $10,828.50 | $10,828.50 | $2,113.24 – $12,188.56 | 111 |
| Tisotumab vedotin-tftv 40 mg intravenous solution HCPCS J9273 | $22,202.40 | $22,202.40 | $8,257.60 – $24,991.02 | 111 |
| Tissue amnio epifix inj 100mg HCPCS Q4145 | $2,555.89 | $3,932.14 | $780.70 – $2,324.76 | 40 |
| Tissue dermagraft 2x3in 37.5sqcm-cost per sq cm HCPCS Q4431 | $67.73 | $104.20 | $39.39 – $117.29 | 40 |
| Tissue exam koh skin/hair/nails CPT 87220 | $28.60 | $44.00 | $16.63 – $49.53 | 40 |
| Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm HCPCS Q4122 | $271.69 | $417.99 | $158.00 – $470.49 | 40 |
| Tissue matrix xcm thk 20x30cm -cost per sq cm HCPCS Q4142 | $49.04 | $75.45 | $28.52 – $84.93 | 40 |
| Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm HCPCS C9358 | $38.88 | $59.82 | $22.61 – $67.33 | 40 |
| Tissue transglutaminase iga CPT 86364 | $176.80 | $272.00 | $102.82 – $306.16 | 40 |
| Tl-201 thallium diag per mci HCPCS A9505 | $80.10 | $80.10 | $30.28 – $90.16 | 40 |
| Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr HCPCS J3260 | $354.15 | $354.15 | $1.36 – $4.05 | 111 |
| Tobramycin peak therapeutic drug level CPT 80200 | $121.55 | $187.00 | $70.69 – $210.49 | 26 |
| Tocilizumab 162 mg/0.9 ml subcutaneous pen injector HCPCS J3262 | $12,214.20 | $12,214.20 | $463.20 – $2,749.73 | 111 |
| Toe X-ray (both feet) CPT 73660 | $270.40 | $416.00 | $104.71 – $311.79 | 40 |
| Tomosynthesis breast diagnostic left HCPCS G0279 | $221.65 | $341.00 | $85.81 – $255.51 | 39 |
| Tomosynthesis breast screen bilateral CPT 77063 | $78.00 | $120.00 | $30.24 – $90.05 | 40 |
| Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution HCPCS J9351 | $188.75 | $188.75 | $43.47 – $129.44 | 40 |
| Toripalimab-tpzi 240 mg/6 ml (40 mg/ml) intravenous solution HCPCS J3263 | $48,786.25 | $48,786.25 | $9,480.00 – $54,913.80 | 111 |
| Toxoplasma antibody igg CPT 86777 | $79.30 | $122.00 | $46.12 – $137.32 | 40 |
| Toxoplasma antibody igm CPT 86778 | $62.40 | $96.00 | $36.29 – $108.06 | 40 |
| Trabectedin 1 mg intravenous solution HCPCS J9352 | $11,842.80 | $11,842.80 | $4,192.10 – $13,330.26 | 111 |
| Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution HCPCS J3290 | $27.60 | $27.60 | $2.00 – $31.07 | 111 |
| Transferrin CPT 84466 | $109.85 | $169.00 | $12.63 – $190.23 | 40 |
| Trastuzumab 150 mg intravenous solution HCPCS J9355 | $4,708.00 | $4,708.00 | $1,250.55 – $5,262.52 | 111 |
| Trastuzumab-anns 150 mg intravenous solution HCPCS Q5117 | $10,508.35 | $10,508.35 | $649.20 – $3,113.47 | 111 |
| Trastuzumab-qyyp 150 mg intravenous solution HCPCS Q5116 | $9,357.40 | $9,357.40 | $429.30 – $3,787.98 | 111 |
| Trauma partial team response w/critical care services level 4 HCPCS G0390 | $2,798.25 | $4,305.00 | $1,301.83 – $3,876.57 | 40 |
| Tray bonemarrw oncontrol 102mm HCPCS C1830 | $699.55 | $1,076.23 | $23.06 – $68.66 | 40 |
| Tray trach basic clean/care ster HCPCS A4626 | $0.55 | $0.84 | $0.32 – $0.95 | 40 |
| Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour CPT 94644 | $241.15 | $371.00 | $140.24 – $417.60 | 40 |
| Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour CPT 94645 | $158.60 | $244.00 | $92.23 – $274.65 | 40 |
| Tremelimumab-actl 20 mg/ml intravenous solution HCPCS J9347 | $127,265.40 | $127,265.40 | $3,862.00 – $11,937.49 | 111 |
| Treponema pallidum antibody CPT 86780 | $130.00 | $200.00 | $75.60 – $225.12 | 40 |
| Triamcinolone acetonide 40 mg/ml suspension for injection HCPCS J3301 | $39.10 | $39.10 | $0.86 – $3.38 | 111 |
| Triglycerides CPT 84478 | $50.05 | $77.00 | $5.63 – $77.00 | 40 |
| Trilaciclib 300 mg intravenous solution HCPCS J1448 | $8,065.15 | $8,065.15 | $1,617.00 – $9,078.13 | 111 |
| Troponin quantitative CPT 84484 | $1,290.57 | $192.00 | $9.09 – $216.12 | 40 |
| Tube drain vert dev st 5-40f HCPCS A5200 | $17.68 | $27.20 | $10.28 – $30.62 | 40 |
| Tube trach disp innr can 5 xlt HCPCS A7521 | $425.24 | $654.22 | $1.28 – $3.82 | 40 |
| Tube trach disp innr can 6 xlt HCPCS A4623 | $2.78 | $4.28 | $0.74 – $2.22 | 40 |
| Tube trach fen sz 6 uncuffed HCPCS A7520 | $128.15 | $197.15 | $0.42 – $1.24 | 40 |
| Ublituximab-xiiy 25 mg/ml intravenous solution HCPCS J2329 | $35,496.45 | $35,496.45 | $10,785.00 – $39,954.80 | 111 |
| Unit mobile power mpu HCPCS Q0479 | $11,821.68 | $18,187.20 | $6,874.76 – $20,471.51 | 40 |
| Unlisted procedure microbiology CPT 87999 | $2,388.75 | $3,675.00 | $1,389.15 – $4,136.58 | 40 |
| Upper Arm (Humerus) X-ray (left side) CPT 73060 | $201.50 | $310.00 | $117.18 – $348.94 | 40 |
| Upper Back (Thoracic Spine) CT Scan (without contrast) CPT 72128 | $1,330.55 | $2,047.00 | $773.77 – $2,304.10 | 40 |
| Upper Back (Thoracic Spine) X-ray (2 views) CPT 72070 | $261.30 | $402.00 | $151.96 – $452.49 | 40 |
| Upper Back (Thoracic Spine) X-ray (3 views) CPT 72072 | $333.45 | $513.00 | $193.91 – $577.43 | 40 |
| Urea nitrogen CPT 84520 | $42.25 | $65.00 | $24.57 – $73.16 | 40 |
| Urea nitrogen 24 hour urine CPT 84540 | $54.60 | $84.00 | $31.75 – $94.55 | 40 |
| Uric acid blood CPT 84550 | $57.85 | $89.00 | $33.64 – $100.18 | 40 |
| Uric acid urine CPT 84560 | $66.30 | $102.00 | $4.98 – $102.00 | 40 |
| Urinalysis microscopic only CPT 81015 | $31.85 | $49.00 | $18.52 – $55.15 | 40 |
| Urinalysis (with microscopy) CPT 81001 | $44.20 | $68.00 | $25.70 – $76.54 | 40 |
| Urinalysis (without microscopy) CPT 81003 | $39.65 | $61.00 | $23.06 – $68.66 | 40 |
| Urine Culture Test CPT 87086 | $58.50 | $90.00 | $34.02 – $101.30 | 40 |
| Urine pregnancy test CPT 81025 | $42.25 | $65.00 | $24.57 – $73.16 | 40 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | $6,677.00 | $6,677.00 | $1,727.70 – $7,515.63 | 111 |
| Ustekinumab 45 mg/0.5 ml subcutaneous solution HCPCS J3357 | $45,913.60 | $45,913.60 | $3,644.10 – $51,680.35 | 111 |
| Vaccine Administration (one shot) CPT 90471 | $95.55 | $147.00 | $7.44 – $22.15 | 40 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | $273.00 | $420.00 | $158.76 – $472.75 | 111 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | $533.00 | $820.00 | $147.06 – $922.99 | 111 |
| Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im CPT 91320 | $98.15 | $151.00 | $57.08 – $169.97 | 111 |
| Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im CPT 91319 | $65.65 | $101.00 | $38.18 – $113.69 | 111 |
| Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im CPT 91318 | $49.40 | $76.00 | $28.73 – $85.55 | 111 |
| Vaccine dtap < 7 years im CPT 90700 | $142.05 | $142.05 | $19.28 – $57.41 | 111 |
| Vaccine dtap-hep b-ipv im CPT 90723 | $95.55 | $147.00 | $55.57 – $165.46 | 111 |
| Vaccine dtap-ipv 4-6 years im CPT 90696 | $54.60 | $84.00 | $31.75 – $94.55 | 111 |
| Vaccine dtap-ipv-hib-hepb im CPT 90697 | $128.70 | $198.00 | $74.84 – $222.87 | 111 |
| Vaccine dtap-ipv/hib im CPT 90698 | $98.15 | $151.00 | $57.08 – $169.97 | 111 |
| Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im CPT 90647 | $37.05 | $57.00 | $21.55 – $64.16 | 111 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.